A man in his 50s with electrical storm after myocardial infarction.

The patient was admitted to a local hospital after a week with several episodes of chest pressure accompanied by dyspnoea. On the day of his admission he suffered acute, persistent chest pain. He was deaf, but otherwise in good health and with no known heart disease. On his arrival at the local hospital he was in pain. An ECG was taken which showed sinus rhythm, incomplete right bundle branch block and ST elevation of 2 – 3 mm in leads V1–V3. Thrombolysis was administered (tenecteplase) according to protocol, and after an hour the patient was free of pain. However the ECG was unchanged, with persistent ST elevation. Rhythm monitoring showed frequent ventricular extrasystoles and several short runs of ventricular tachycardia. There was also an episode of persistent ventricular tachycardia that required electroconversion. Inadequate reperfusion was suspected, and the patient was therefore transferred by air ambulance to the nearest university hospital for rescue PCI.